The present application relates to a suture manipulating instrument for use during a surgical operation. The invention is particularly useful with respect to instruments manipulated via endoscopes during minimal invasive surgery, and is therefore described below with respect to such an application.
In minimally invasive surgery all operations must be performed through a narrow opening, the size of which limits the size of the instruments used and the free space available to manipulate them. Various small-size cutting, grasping, debriding and stitching instruments, capable of operating through small portals, have been developed for this purpose.
Internal suturing is necessary in many endoscopic procedures in order to close wounds or to reattach tissue which became detached from its normal position. In many such procedures, a strand of suture is introduced from the outside to the location to be sutured. The suture is then passed through a layer of tissue and retrieved from the exit side. In other cases, a suture attached to an anchoring element must be captured and passed through tissue.
Many suture passing and stitching devices are available to the endoscopist. Examples of such devices are described in U.S. Pat. No. 5,499,991 (Linvatec), and U.S. Pat. No. 5,222,977 (R. D. Esser), and in the publication “Arthroscopic Meniscus Repair”: Journal of Arthroscopy Vol. 9, No. 2, p. 231 by R. D. Esser, as well as in Catalogs of Linvatec-Concept Inc., Arthrex Inc. However, all the known devices are limited in the functions capable of being performed, in the direction of approach, or in their maneuverability within the limited space available.
The aim of this invention is to provide a novel design having advantages with respect to one or more of the above-mentioned limitations of existing devices and offering an optimal solution to endoscopic suture management.